December 2023 - 3 min read

Are you missing out on significant unrealized reimbursements available for dementia care?

More than 7 million people in the US suffer from some form of dementia. Identifying and caring for these patients presents unique challenges but can also bring opportunities to primary care practices seeking new avenues for enhancing patient care that are supported by reimbursement. Proven reimbursement models exist for both value-based and fee-forservice practices.

Value-Based Practices and Risk Bearing Entities

For value-based practices, proper diagnosis of dementia entitles practices to receive risk adjustment factor payments per dementia patient on an annual basis to support their care. The potential financial gain can be substantial—on average $2.4M per 10,000 patients under care. In addition to the initial financial gain to the practice, the identification of these patients supports the reduction of downstream costs by caring for this population earlier in their diagnosis when intervention can be most effective. It all comes down to detection.

Fee-for-Service Based Practices

For fee-for-service practices, there are permanent billing codes that can be used for both cognitive function assessment and care planning for dementia patients. ‘Test Administration’ codes provide reimbursement for testing administered by a physician, qualified health professional, or technician. The mode of completion can be manual, e.g., paper and pencil, or via computerized means. ‘Test Evaluation’ codes enable practices to bill for professional activities, e.g., Neurocognitive / Neuropsychological, Neurobehavioral, Developmental / Behavioral Testing Procedure(s).

The Growing Role of Quick Cognitive Assessment

So how can practices identify dementia patients quickly and accurately without undue burden on the practice workflow? New and effective quick digital assessments take minimal staff time and are designed to identify cognitive impairments early in the diagnostic process. By incorporating these important tests into routine patient visits, primary care physicians can identify potential dementia patients at an early stage, allowing for timely treatment and improved patient outcomes. Qr8 Health offers quality cognitive assessment designed for real-world primary care settings.

The Importance of Early Identification

One significant challenge in dementia care is that an alarmingly large percentage—an estimated 76% of those afflicted, remain undiagnosed by their primary care physicians. This represents a significant gap in patient care.

Recognizing dementia in its early stages:

  • allows for timely interventions and appropriate treatments that can help slow disease progression and improve a patient’s quality of life.
  • enables access to much-needed support services and resources, including counseling, caregiver assistance, and community programs.
  • leads to better management of comorbid conditions, reducing the risk of complications and hospitalizations.
  • identifies patients that may be eligible for clinical trials.

Subjective vs Objective Measures

One of the reasons for the gap in identifying those with dementia is the reliance on subjective memory complaints. Most primary care physicians typically wait for patients or their family members to report memory problems before conducting further assessments. However, research shows that subjective memory complaints do not often align with objective measures of cognitive function. Regular assessment of cognitive function would eliminate the need for primary care health care professionals to deduce who needs evaluation and who does not.

Investing in Dementia Care: A Win-Win Opportunity for Primary Care Practices

Caring for patients with dementia is not only a medical imperative but also allows for additional financial support for primary care practices. By taking proactive steps to identify dementia patients within their existing patient populations and implementing user-friendly assessments, practices can both elevate the quality of patient care and tap into valuable reimbursement opportunities. This dual approach not only benefits patients but also supports the sustainability and growth of primary care practices, showcasing the potential for a win-win scenario in healthcare.

To learn more about the latest assessment and reimbursement opportunities including an analysis of what these can mean for your individual practice, please contact the Qr8 Health team at info@qr8health.com or visit the website https://qr8health.com.

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